Health care seen wanting, but access better

Report reviews how states provide for low-income people

Updated 7:33 am, Wednesday, September 18, 2013

How to improve health care for low-income Americans? Supporters of the Affordable Care Act say the key is expanding access to health insurance.

But in New York, that situation appears flipped, according to a report to be released Wednesday by The Commonwealth Fund.

Low-income New Yorkers fare better than residents of most other states at getting affordable medical services. But their illnesses are not always prevented or treated as effectively as other Americans, and they are more likely than most to end up in the hospital when such a trip could be avoided.

That's according to "Health Care in the Two Americas," a report examining low-income people's experience getting health care in 50 states and the District of Columbia.

New York ranked 17th on measures intended to show how well the state's health care system serves low-income families. About 40 percent of New Yorkers were considered low-income, defined as earning 200 percent of the federal poverty level — $22,980 a year for an individual and $47,100 a year for a family.

The state was listed among the best performers in making health care accessible and affordable to low-income residents. It also scored well on measures indicating residents lead long, healthy lives, including relatively low rates of obesity and premature deaths.

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But it landed among the lower half of states on measures of prevention, treatment and avoidable hospital admissions.

The reasons lie mostly in problems downstate, said Cathy Schoen, the report's lead author.

Asthma-related hospitalizations among children from low-income communities in New York were eight times higher than in Oregon, the state with the lowest rate. New York City health officials are working to remove asthma triggers from deteriorating homes, Schoen said.

The state's health system, especially downstate, is fragmented, with lots of specialty care and insufficient coordination, Schoen said. That accounts for high rates of readmission to the hospital for the same condition, among other things.

The system "doesn't do as well at keeping people safe in the community as it could," Schoen said.

Current health care reform efforts seek to coordinate services better and to get medical care to people early in their illnesses when care is less costly and more effective.

The state ranked 50th out of 51 in the percent of hospitalized patients informed about recovering at home, and in the percent of those who reported that hospital staff managed pain well, responded when called for help and explained medicine and side effects.

It was among the top three states for low out-of-pocket medical costs, avoiding use of high-risk medications in elderly patients and low rates of premature death.

Nationwide, Northern states performed better than Southern ones on the report's ranking. Low-income people in high-performing states fared better on some measures than high earners in states with poorer health performance.

"Where you live plays a very big part in your experience," said Commonwealth Fund President David Blumenthal.

The Commonwealth Fund is a New York City-based foundation that supports independent research on health policy.